Forms

If you're a DUI client, please complete the following forms and bring them to your first therapy session.

• Demographic Data Sheet
• Financial Policy
• Service Fee Policy

If you're a new client, please complete the following forms and bring them to your first therapy session.

• Intake form
• Personal Information Sheet
• No Surprise Faith Estimate Notice
• IL Informed Consent Teletherapy
• IL Informed Consent
• HIPAA Client Rights and Privacy Practices
  
  

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

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